Publicly funded cancer trials save more than 3 million years of life

People diagnosed with cancer gained 3.34 million years of life thanks to cancer clinical trials run by SWOG and supported with public funds, according to new study results to be presented at the 53rd Annual Meeting of the American Society of Clinical Oncology (ASCO), the world's largest clinical cancer research meeting. The dollar return on investment from federal funding, the study showed, was estimated to be just $125 for each life year gained.

SWOG biostatistician Joseph Unger, Ph.D., of Fred Hutchinson Cancer Research Center, led the work and will present it on a June 5 ASCO panel. Results will be simultaneously published online in the journal JAMA Oncology. SWOG is a cancer clinical trials network funded by the National Cancer Institute (NCI), the federal government's leading cancer research agency.

"The NCI's investment in SWOG and our network has resulted in a significant benefit to the American public," Unger said. "A lot of people with cancer have lived longer because of the therapies tested in our publicly-funded trials. At the same time, the cost of this research is relatively low. So with high impact and low cost, it's a great value for taxpayers."

"This collection of data combining years of research shows a dramatic extension of life gained by participation in, or as a result of, clinical trials," said Dr. Jeff Abrams, associate director of NCI's Cancer Therapy Evaluation Program. "This provides a new metric for assessing the value of publicly supported cancer research."

In 2016, SWOG celebrated its 60th anniversary as part of the NCI's National Clinical Trials Network and NCI Community Oncology Research Program. SWOG treatment and prevention trials have enrolled more than 200,000 patient volunteers, and led to the approval of 14 new cancer drugs and more than 100 changes to the standards of cancer care. But what is the human impact of these medical innovations? How much longer do people live because of them?

With the SWOG anniversary, and the spotlight on cancer research cast by the federal Cancer Moonshot initiative, Unger and his colleagues wanted to study SWOG's long-term impact.

Last summer from his office at Fred Hutch, Unger began poring over SWOG study data from 1956 to 2016. He identified 193 Phase III randomized trials - the gold standard in clinical research - for analysis. These trials all tested new drugs or procedures against current therapies to see if they improved "overall survival." This term refers to how long someone lives after they're diagnosed with cancer, or when they start treatment. Of those 193 completed trials, Unger identified 23 that showed a statistically significant increase in overall survival due to the new therapy. These studies enrolled a total of 12,361 patients diagnosed with a variety of cancers, including lung, breast, skin, and prostate, as well as blood cancers such as leukemia, lymphoma, and myeloma.

Unger devised a statistical model using an analytical framework that assumed the new trial-proven treatments would become the standard of care, that the effects would last for five years, and that all future patients diagnosed with those cancers would benefit from the new treatment. Using data from the NCI's Surveillance, Epidemiology, and End Results (SEER) Program, which tracks cancer cases in the U.S., he estimated the number of people to whom the new treatments would apply. He also estimated how long those people were likely to live, and the period of post-treatment benefit. Then he calculated the cumulative life years gained from each trial, and tallied up the gains from all 23 studies through the end of 2015.

The grand total: 3.34 million years of life gained. Even when Unger adjusted his model to account for the fact that not all patients may get the new treatment, and even when he lowered the effect of the new treatment to three, not five years, the model showed a benefit of at least 2 million years in nearly every simulation.

Unger calculated the dollar return on investment using federal budget data to create an inflation-adjusted estimate of $418 million in NCI funding to SWOG over its 60-year history in 2015 dollars. Unger will present his work at an ASCO 2017 poster discussion session on June 5 from 4:45 to 6 p.m. in S504 in Hall A of McCormick Place in Chicago. ASCO 2017 will attract more than 30,000 cancer professionals to discuss new cancer treatments and research findings.

"Time is the most priceless gift we have, and the ability to give people with cancer more time with their loved ones is a major achievement," said SWOG Group Chair Dr. Charles Blanke, the senior author of this abstract. "To put the numbers in context, the most conservative estimate of 2 million years is the equivalent of giving about three extra years of life to every one of the estimated 600,000 Americans expected to die of cancer this year. This is an exceptional benefit to come out of federally-funded cancer research."